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Transference-Love and Institutional Involvement in a Case of Psychotherapy Supervision
Abstract
Transference-love in supervision remains a relatively unexplored subject in psychotherapy. This article describes and analyzes an incident of the supervision of a student whose dress code raised a question regarding the existence of transference-love. The role of the institution in maintaining a protective envelope is shown to be significant in the satisfactory resolution of what appeared to have been an impasse. In addition, multicultural and gender issues are examined to illustrate the complexity of the subject.
... Social constructionism (the view that people and their engagement with others create knowledge) allows for an appreciation of diverse perspectives (e.g., age, gender, ethnicity). This stance supports supervisees and supervisors in exploring and understanding different perspectives in their work together (Alfandary, 2016;Asakura & Maurer, 2018). In the following, I present a clinical case example in which I aim to demonstrate some aspects of intersubjective exploration within a triad in a clinical social work supervision setting. ...
Intersubjectivity is described in the psychoanalytic literature as a treatment encounter consisting of two participants, each with a particular subjectivity and perspective, engaged in an interactive process in which the therapeutic partners are simultaneously influencing and being influenced in their experience of self and other. In intersubjective supervision, two subjects participate, interact, and influence each other; both members process the supervisees’ therapeutic experiences, and the supervisor’s countertransference is considered inevitable and integral to the supervision process. In the current paper, intersubjectivity and supervision are reviewed, and a clinical case example is provided to demonstrate some of the core components of intersubjectivity in a supervision setting and how to apply it in clinical social work fieldwork. The case example illustrates a supervision encounter between a social work supervisor-in-training and his supervisee and how they develop self-awareness of more profound aspects of their subjectivities. It sheds light on the supervisor-in-training’s willingness to explore and analyze his countertransference and the unconscious when tension and conflict develop within the supervisory dyad. Conflicts within this dyad were analyzed in group supervision as a function of the supervisee’s and the supervisor-in-training’s defensive operations and resistance to differences in approaches. Teaching vs. treating in supervision was also discussed. Developing self-awareness allowed the supervisor-in-training to reflect on the role of his subjective perspective in his clinical approach, fears, and wishes yet also attune himself affectively to the subjective emotional states of his supervisee. Reflective self-consciousness enabled the supervisor-in-training and the supervisee to experience supervision more creatively.
When confronted with ruptures in therapeutic relationships, therapists occasionally develop feelings of guilt and remorse over their contributions to the therapeutic process and feel pressured to activate internal processes of reparation. Supervisors attend to their supervisees' reparation processes and help them to differentiate between imagined and actual damage to the patients' welfare and to the integrity of the therapeutic relationship. The supervisors participate in the supervisees' internal processes in a peripheral way while maintaining the integrity of the therapeutic process and the patients' safety and interests. This type of backing enables supervisees to grow as clinicians and cope successfully with daily clinical challenges by taking care of the relational ruptures in therapy through investigating the empathic failures and mutual enactments in the therapeutic space.
The analyst's countertransference feelings of love, particularly sexual love, have been subject to minimal examination in the literature. In this era of expanding psychoanalytical models, it appears that some theories of therapeutic action lend themselves more to addressing such themes than do others. There is always considerable overlap among psychoanalytic models, although there are nonetheless some clear differences in the way countertransference affect is experienced, filtered, and utilized.
The psychoanalytic exploration of the analyst's erotic counter‐transference has remained a subject rarely addressed in open colle‐gial dialogue. This paper addresses this professional reticence as a manifestation of two interwoven resistences. The first, an avoidance of the physiologically based substrata of self and object organization growing out of certain preconceptions derived from a structural‐drive model. And the second, an unwillingness to view the parent/analyst as a full participant in the child's romantic oedi‐pal struggles. An alternative formulation based on a reconfigured, relational model of mental structures is suggested. Here the physical experience of self in relationship to a host of significant internalized others becomes a meaningful organizing component for both the patient and the analyst, one that must be incorporated into the ongoing exploration of transference—countertransference manifestations. Likewise, the unfolding oedipal situation between parent and child, patient and analyst, is viewed from the perspective of a two‐person model within which the shared symbolic participation of both becomes a necessary prerequisite for the kind of resolution that lays the groundwork for mature love. A clinical example in which the analyst felt it necessary to disclose the presence of erotic countertransference is explored from several perspectives.
The erotic transference can be seen as the Janus face of clinical work in psychoanalysis: it may either arise out of the positive emotions necessary for the building of new shared realities, or be fueled by falsified and distorted constructions. In the former case, the erotic transference expresses the capacity to anticipate, or "dream," the emotional relationship with the object-which is why Freud valued its transformative aspect as one of the "forces impelling [the patient] to . . . make changes"-whereas in the latter it is equivalent to a flight from psychic reality and may be imperceptibly transformed into an actual delusion.
The therapist's erotic desires towards the client is a much tabooed and little discussed subject within psychoanalysis and psychotherapy. It is suggested that this topic needs to be opened up for scientific exploration and discussion. This paper is an investigation into the nature of the therapist’ s erotic subjectivity. A review of the literature suggests how difficult it is for many analysts to deal with their erotic desires towards the client completely successfully. Some clinical examples are given to illustrate how the therapist's erotic desires may make a positive contribution to the analysis. It is suggested that erotic desires are inevitable and are part of a healthy Oedipal development. The child needs to internalise and identify with the opposite sex parent's ability to contain incestuous longings. Like the parent, the therapist can expect to have sexual feelings for his or her clients. It is further suggested that objective erotic desires can be as useful as any other feeling the therapist might experience so long as they are analysed and understood in the client's interest.
A case is presented in which the patient's transference to the analyst's supervisor became evident just prior to the switch from clinic to private patient status. The patient experienced the supervisor as a restraining father figure who protected her from acting on her erotic wishes toward the analyst. Analysis of this led to the recall of previously repressed memories of sexual wishes toward her brother, and the sense of protection from these wishes that she had gotten from the presence of her father. The literature on transference involving the supervisory constellation and the training setting is reviewed, and the concepts of split and institutional transference are examined. Factors inhibiting the analysis of patients' fantasies about the analyst's status as trainee, including the presence of the supervisor and the institute, are discussed.
Within a set of phenomena traditionally problematic for psychoanalysis, four types of erotic transference are outlined with a description of their dynamic genesis and related case histories (transference and countertransference developments, fundamental treatment procedures): erotised, erotic, loving, and affectionate transference. The first type is based mostly on psychotic modalities, the second on neurotic modalities. Both the loving and the affectionate transference, on the other hand, turn out to be clinical forms corresponding to a normal substantially same development, different from each other by virtue of a diverse level of maturation in the Oedipus complex: they often provoke--in analysts--a defensive stiffening which is harmful and--from the theoretical point of view--not above reproach. The work is particularly focused on the analytic evolution of a female patient who develops an amorous transference in which the defensive aspects prove to be less important than the potentially evolutionary ones. The treatment has been based--in particular--on the analytic utilisation of this transference. The last part of the contribution is devoted to the analysts' 'guarantee factors', which permit them to work in psychoanalysis with the 'highly explosive forces' of these transference configurations, maintaining a useful, rigorous, sensitive and sufficiently creative framework.
The author argues that an intersubjective perspective on the analytic process makes the notion of purely didactic supervision, avoiding countertransference issues, untenable and that countertransference is both a clue to the analysand's psychic reality and a factor in its evolution. Supervision is seen as a highly personal learning process for both supervisor and supervisee and its emotional climate as a crucial factor in its evolution into a transitional space, generating new meanings. Supervision is portrayed as the crossroads of a matrix of object relations of three persons, of a complex network of transference/countertransference patterns. The avoidance or denial of the supervisor's subjective role in it, maintaining 'a myth of the supervisory situation', may make supervision stilted or even oppressive and stand in the way of resolving supervisory crises and stalemates. It is argued that several factors contribute to the conflictuality of supervision for all partners (often including the analysand): the continuous process of mutual evaluation, the reciprocal fears of exposing one's weaknesses, the impact of the institute as a setting and the transferences it arouses and the inherent conflicts of loyalty for each participant in the analytic/supervisory triad. The resulting dynamics and relational patterns could become a legitimate and freeing topic in supervisory discourse.
The emotions experienced by a supervisor including even his private, 'subjective' fantasy experiences and his personal feelings about the supervisee often provide valuable clarification of processes currently characterizing the relationship between the supervisee and the patient. In addition, these processes are often the very ones which have been causing difficulty in the therapeutic relationship and, because heretofore unrecognized by the supervisee, have not been consciously, verbally reported by him to the supervisor. This thesis is undoubtedly well known to many persons engaged in supervision, and in everyday use by them in this work; but my own experience indicates that it is far from universally recognized, and it has not been presented in the literature, to the best of my knowledge. It would be at least equally valid to express the principle in the following fashion: the processes at work currently in the relationship between patient and therapist are often reflected in the relationship between therapist and supervisor. But it makes for simplicity of presentation to present this material from the viewpoint of the supervisor.
The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifically, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-reflection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specific modifications of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality.
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